A panel of global experts has issued a strong rebuke against the World Health Organization, accusing it of numerous failures in both technical judgment and leadership in its response to the Ebola outbreak, a mistake that the panel said led to "thousands" of deaths that could have been prevented.

Their report, published in The Lancet this week, detailed missteps that took place at every stage of the epidemic -- from the inadequate investments in health infrastructure that left Guinea in such a state that it was unable to detect the virus for several months to the WHO's delay in mobilizing global assistance even as the number of cases grew exponentially.

"The outbreak engendered acts of outstanding courage and solidarity, but also immense human suffering, fear, and chaos, largely unchecked by high-level political leadership or reliable and rapid institutional responses," Peter Piot, a co-discoverer of the Ebola virus, and the other panel members wrote.

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The 19 members of the group include experts from academia, think tanks and civil society organizations and were brought together by the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine.

"Our primary goal," they said, "is to convince high-level political leaders worldwide to make necessary and enduring changes to better prepare for future outbreaks while memories of the human costs of inaction remain vivid and fresh."

For analytical purposes, the panel divided the epidemic into four phases and detailed the issues during those times:

December, 2013 to March, 2014: The first infections occurred in a remote rural area of Guinea.

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  • "The lack of capacity in Guinea to detect the virus for several months was a key failure, allowing Ebola eventually to spread to bordering Liberia and Sierra Leone."
  • There had been "inadequate investments in health infrastructure, despite previous formal commitments by national governments."
  • There were "inadequate arrangements between governments and WHO to share, validate, and respond
    robustly to information on outbreaks"

March 2014: Intergovernmental and nongovernmental groups began to respond. Guinea and Liberia confirmed Ebola outbreaks.

  • "Without any approved drugs, vaccines or rapid diagnostic tests, health workers struggled to diagnose patients and provide effective care."
  • "Without sufficient protective gear, and initially without widespread understanding of the virus, hundreds of
    health workers themselves became ill and died."
  • "Despite Médecins Sans Frontières’ warnings about the unprecedented scope of the outbreak, national authorities in Guinea downplayed it for fear of creating panic and disrupting economic activity. Internal documents suggest similar concerns might have influenced WHO, which publicly characterised the outbreak in March as 'relatively small still.'"
  • WHO’s in-country technical capacity was weak. "WHO’s Global Alert and Response Network sent an expert team to support national efforts, as did others such as the US Centers for Disease Control and Prevention. However, those teams withdrew from Guinea and Liberia in May when reported cases decreased, even as viral transmission continued."
  • "Coordination was weak between the national governments of Liberia, Guinea, and Sierra Leone, the borders extremely porous, and human movement and trade highly fluid."
  • "WHO did not mobilise global assistance in countering the epidemic despite ample evidence the outbreak had overwhelmed national and non-governmental capacities — failures in both technical judgment and political leadership."

July 2014: Cases, global attention, panic, and responses all grew. On Aug. 8, the WHO Director-General officially designated the Ebola outbreak a public health emergency of international concern.

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  • "Ebola treatment centres in all three countries were stretched beyond capacity and forced to turn away patients at their gates."
  • "A growing lack of trust between population groups and government authorities hindered community mobilisation and public education."
  • "Public and private restrictions on trade and travel further harmed an already suffering region and hindered
    control efforts."
  • "The operational response commenced slowly, taking months for funding, personnel, and other resources to reach the region."
  • "The creation of the UN Mission for Emergency Ebola Response bypassed the pre-existing UN body for
    emergency coordination, the Office for the Coordination of Humanitarian Affairs, further blurring the lines of
    responsibility for international coordination."
  • "Field often reinvented strategies for community mobilisation and contact tracing because relevant lessons from previous Ebola outbreaks in Uganda and the Democratic Republic of Congo were not effectively transferred."
  • "International staff with Ebola sometimes received experimental therapies (albeit, the efficacy and risks of which were unknown) and were evacuated while national staff largely were not, a  demoralising and often deadly distinction for many health workers."
  • "There was poor understanding of how to take into account community beliefs, practices, and solutions, properly address rumours, and involve local leaders—with sometimes fatal consequences for health workers and communities."

End of 2014: The epidemic turned a corner. The total number of cases began to decline in the hardest hit countries. Large-scale global assistance arrived.

  • "By the end of January, 2015, more than $5 billion had been committed for the Ebola response (although the proportion of these funds actually spent on Ebola and in the affected countries remains unclear)."
  • "During this phase, the binding constraints were no longer political attention, funding, or human resources, but operational coordination, accountability for effective use of funds, and maintaining momentum to prevent new infections."
  • "In west Africa more than 800 local health workers contracted Ebola caring for the sick; more than 500 of those caregivers died."
  • "Positive steps notwithstanding, this Panel’s overarching conclusion is that the long-delayed and problematic international response to the outbreak resulted in needless suffering and death, social and economic havoc, and a loss of confidence in national and global institutions."

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